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Editor's Note
October 2014

It’s Not Just About the Money, Money, Money…

JAMA Intern Med. 2014;174(10):1696. doi:10.1001/jamainternmed.2014.3374

Global funding for biomedical research now approaches $270 billion per year, nearly two-thirds of which comes from industry, including pharmaceutical, biotechnology, and medical device companies.1 While industry’s investment in research has spawned breakthroughs and innovations, these investments have also fueled concerns that industry-funded clinical trials are more likely to have proindustry conclusions,2 potentially distorting the evidence base to favor more expensive, brand name products on which manufacturers continue to spend research dollars.

Having examined a year’s worth of clinical trials published in high-impact biomedical journals, the findings of Roper et al3 suggest that the problem may go beyond funding and instead be a consequence of collaboration. When compared with trials not funded by industry, trials funded by industry were no different with respect to key design features suggestive of methodological rigor or likelihood of reporting proindustry conclusions. However, trials funded by industry that also involved collaboration in its design, analysis, or reporting used less rigorous methods and were more likely to report proindustry conclusions.

Appropriate research collaborations focused on patient benefits should be fostered, taking advantage of the skills and knowledge of those in industry and academia (and government). However, perhaps collaboration breeds sufficient familiarity and generosity that decisions are affected, even if only subtly, in a way that diminishes the rigor and robustness of the research. Ensuring that these collaborations are made fully transparent, including the process of study design and decisions relevant to study conduct and statistical analysis, may help, as might independent oversight or advisory committees. By human nature, I suspect we are all inclined to make small concessions to those with whom we work, regardless of whether they are employed by a pharmaceutical company funding our research or work at the front desk of our clinics. So we must be mindful and remember, it’s not just about the money.

References
1.
Chakma  J, Sun  GH, Steinberg  JD, Sammut  SM, Jagsi  R.  Asia’s ascent—global trends in biomedical R&D expenditures.  N Engl J Med. 2014;370(1):3-6.PubMedArticle
2.
Bekelman  JE, Li  Y, Gross  CP.  Scope and impact of financial conflicts of interest in biomedical research: a systematic review.  JAMA. 2003;289(4):454-465.PubMedArticle
3.
Roper  N, Zhang  N, Korenstein  D.  Industry collaboration and randomized clinical trial design and outcomes [published online August 25, 2014].  JAMA Intern Med. doi:10.1001/jamainternmed.2014.3590.
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